Unsolicited Advice for Republicans: Call Trump’s Bluff on Health Care

Donald Trump is leaning hard on Republicans in Congress to support whatever version of health care reform hits the floor of the House later this week. Members of Congress concerned that the bill might hurt their constituents (and ultimately their own re-election prospects) may be willing to go along with Trump because if they don’t, Trump might show up in their districts and campaign against them. Fear that things might go badly in a year and a half are overwhelmed by fear of angering the President and getting criticized today. Between this particular rock and a hard place, the politically better choice for most Republicans is opposing the President now.

When faced with a choice between doing what the President wants today to avoid the pain of being loudly called out by Trump on one hand, and the threat of losing a primary or general election in 2018 because Republicans failed to repeal and replace the Affordable Care Act in a year and half on the other, it is understandable why many would vote yes and hope for the best. Over-weighting immediate risks and discounting future risks or potential gains is something people do. The idea was captured in Prospect Theory: an Analysis of Decision under Risk, a seminal piece in the field of behavioral economics and a reason Daniel Kahneman won a Nobel Prize in 2002. But, as Kahneman and his co-author Amos Tversky note in their research, the reaction is often the wrong one.

The Immediate Threat

Your Party ran on repealing and replacing Obamacare. If you vote “no” now there might not be another bill – and if there is, that bill might be worse. Either way, you risk facing an angry electoral base and the threat of a primary challenge from the right. You also face the prospect of an angry and unpredictable Donald Trump. He could come to your district and rally the base, he could tweet at you, he could accuse you of all sorts of things you didn’t do, and who knows what else. Outside groups will also make a lot of noise, could run ads attacking you, and otherwise make your life unpleasant. In addition, your staff might agree with the bill on the floor and push you to forget politics and vote on the policy, or they might share your political concerns (policy aside). And then there are your colleagues, your fellow Republicans with whom you fundraise and socialize (often at the same time). Those all add up to a good reason to vote “yes” now and sort out the damage later.

The Longer Term Threat

If you vote “yes” and the bill becomes law, you face another set of challenges. While Obamacare is unpopular, the Affordable Care Act and its state-variations are increasingly well liked. Voters feel pretty strongly about elements of the ACA, and have serious concerns about potential replacements. A “yes” vote therefore both accomplishes what your constituents want and simultaneously do what they don’t want. And then there are the policy implications of the law – by most accounts, under Trump’s bill, fewer people will have insurance and rates will rise for those who are insured well past the next election. You will have literally voted to hurt your own voters. As someone who has been doing strategic political communication for 25 years, that is not a course of action I would recommend. You are also tying your political fortunes to a slowly sinking political stone – only slightly more Americans support Trump than love avocado toast. Voting for the bill and avoiding pain today might only make things worse 18 months or so from now.

There are two reasons to choose the latter bad option over the former bad option.

First, you are a politician and think in terms of policy and electoral consequences. The President is not. He is a businessman (one who might be $10 billion richer if he had put his inheritance in index funds rather than try to make money, in real economic terms that means he lost $10 billion dollars by working rather than napping). He is a very good salesman however. In real estate speculation, the sale is what matters, not the quality of the product being sold. Salesmen push a promise of great returns and a great deal to people who know they could lose that money on a bad gamble. If he project works then everyone gets richer. If the project fails, the company declares bankruptcy and everyone takes a tax write-off. Given the array of opinions he has expressed on an array of policies, it is pretty clear that the policies themselves matter less than his ability to get people to support them. As a sales guy, he is trying to get you to buy a partially completed building that you will then have to live in. If the roof leaks or there are rats in the basement, well that’s too bad, you bought it. He will get credit for the sale, take his commission, and walk away. He doesn’t care about the price you will pay at the polls or the price your voters will pay with their health. To negotiate with someone who deals in sales you need to be a salesman, not a statesman. And the first rule of any business negotiation is that the other person needs to believe you are willing to walk away from the deal. If the person on the other side of the negotiation doesn’t think you will walk away, you will lose the negotiation every time. Donald Trump is banking on your being a bad negotiator. If he is right, he will win. And remember, in Trump’s world that means you will lose. It is only by walking away that you will have any power to effect policy with Trump. If you always agree, you will always get rolled.

Second, November 2018 is a long way away. If you fight hard for your constituents, vote against the bill, and it passes, you can claim credit for making the final bill better because you were willing to go toe to toe with Trump. If you vote no and the bill fails, you can help lead the charge for a better bill that preserves what your constituents want and need, and you can run on that success. All the bluster and attacks and tweets and rants today have zero impact today. You are a Member of Congress, and barring a coup or an indictment, you will be a Member of Congress a year from now. Let him shout, so what? If he comes to your district, join him. Ask him about Russia. Ask him about all the money your constituents are spending to keep his wife and son in New York – money that could go to cutting taxes or fixing roads. Ask him about all the money your constituents are spending on his private resort and golf outings rather than on schools or addressing the opioid crisis. Take him on. Make him come to your negotiating table, force his hand on your deal. And let’s face it, given the direction Trump’s numbers are trending, you might want to start creating some distance from him.

I do not offer this advice happily. Part of me wants to say that this mess is of your own making, deal with it. The Affordable Care Act is largely a Republican bill. You are the ones who decided to attack your own creation for short-term partisan gain. Because of your own short-sightedness you are now in the position of explaining why are you are taking away health care from roughly the combined populations of Kansas, New Mexico, Nebraska, West Virginia, Idaho, Hawaii, New Hampshire, Maine, Rhode Island, Montana, Delaware, South Dakota, North Dakota, Alaska, Vermont, Wyoming, and the District of Columbia. It is also true that I am a partisan. I worked on the Affordable Care Act, was an Obama appointed senior adviser to the Commissioner of the Food and Drug Administration, and get my health insurance on the local exchange. So please, feel free to ignore my advice. If you do, millions will likely suffer, but my friends’ electoral chances will probably improve.